When and for whom is enacted stigma associated with alcohol and cannabis use at the event level among sexual and gender minority older adults?

Abstract

Objective: Sexual and gender minorities (SGM) are at elevated risk for alcohol and cannabis use disorders compared to cisgender, heterosexual individuals. This has been attributed to the unique stressors that SGM experience (SGM stress); however, recent studies have found mixed evidence for a link between SGM stress and substance use. The present study tests an integrated theoretical model derived from minority stress theory and the multistage model of substance use to explain these mixed findings.

Method: We used data from a 30-day ecological momentary assessment study of substance use among 109 SGM older adults (50+) to examine whether event-level associations between enacted stigma and alcohol and cannabis use, quantity consumed, and consequences are dependent on an individual's typical pattern of substance use (e.g., frequency, coping motives, and substance use disorder symptoms).

Results: Findings indicate that, at the event level, enacted stigma was associated with increased likelihood of alcohol use among those who had a probable alcohol use disorder. Further, SGM with more alcohol use disorder/cannabis use disorder symptoms and who used alcohol to cope were more likely to engage in heavier cannabis use and experienced more alcohol consequences when they experienced enacted stigma. However, several other moderations were not significant, contrary to hypotheses.

Conclusions: Findings provide partial support for an integrated theoretical model incorporating minority stress theory and the multistage model of substance use. Findings suggest that alcohol and cannabis use disorder interventions for SGM would benefit from addressing minority stress. (PsycInfo Database Record (c) 2025 APA, all rights reserved).